Varus Ankle Arthritis: A Modified Operation With a Novel Osteotomy and Lateral Hinge Plate Fixation Technique

If you or someone you know lives with ankle pain that makes walking, climbing stairs, or even standing difficult, you know how much it can disrupt daily life. Ankle arthritis—especially when it causes an inward foot tilt (varus deformity)—is a common culprit. For years, supramalleolar osteotomy (surgery to reshape the lower shinbone just above the ankle) has been a go-to treatment to realign the joint and reduce pain. But traditional osteotomy has drawbacks: frequent X-ray use during surgery, no early movement, and a risk of the outer (lateral) bone splitting—leading to instability, slow healing, or implant failure. Now, a team of Chinese orthopedic experts has developed a modified technique that addresses these issues—and early results are promising.

Who Led the Study?

The research was conducted by a team from top Chinese medical institutions:

Xiao-Hui Gu (First Affiliated Hospital of Soochow University & Zhejiang Provincial People’s Hospital)
Xin-Ji Chen (Second Affiliated Hospital of Wenzhou Medical University)
Chao Sun & Jian-Zhong Zhang (Beijing Tongren Hospital)
Zong-Ping Luo (First Affiliated Hospital of Soochow University, corresponding author)

Their findings were published in the Chinese Medical Journal in 2019.

How the Modified Technique Works

The team reviewed 16 patients with varus ankle arthritis (average age: 57.7 years) who underwent the modified procedure between 2015 and 2019. All were followed for an average of 23 months to track outcomes. Here’s a simplified breakdown of the surgery:

Clean the Ankle Joint: A 4 cm incision was made on the front outer side of the ankle. Surgeons removed bone spurs (osteophytes) and inflamed tissue (synovium) from the joint to reduce pain and improve mobility.
Place the Lateral Hinge Plate: A pre-shaped three-hole plate (bent to match the desired correction angle) was attached near the syndesmosis—the ligament connecting the tibia (shinbone) and fibula (calf bone) at the ankle. Screws were tightened halfway to keep the plate in place.
Mark the Osteotomy Line: A small pin (Kirschner wire) was inserted through the plate’s center hole, aiming 4.5 cm above the inner ankle bone (medial malleolus). Using this pin as a guide, a second 8 cm incision was made on the inner side of the tibia to expose the bone.
Perform the Osteotomy: A wide saw cut the tibia along the pin, stopping 5 mm from the outer (lateral) bone—visible directly through the first incision. The leg was adjusted to the correct angle, and a wedge-shaped bone graft (taken from the patient’s hip) was inserted into the gap.
Secure the Bone: The lateral plate screws were tightened fully, and a second locking plate was added to the inner tibia for extra stability. Fluoroscopy (real-time X-ray) was used once to confirm alignment.

Key Results

After surgery, patients showed significant improvements:

Pain Relief & Function: Ankle function (measured by the American Orthopaedic Foot and Ankle Society [AOFAS] ankle-hindfoot score) improved dramatically.
Deformity Correction: The tibial articular surface angle (a measure of ankle alignment) returned to normal, fixing the varus tilt.
Fewer Complications: No patients experienced lateral cortex splitting, slow healing (delayed union), or failed healing (non-union)—common issues with traditional osteotomy.

Why This Technique Is Better

The modified procedure solves major flaws in traditional surgery:

Fewer Incisions: The front outer incision serves two purposes—cleaning the joint and placing the lateral plate—so no extra cuts are needed.
Less Radiation: Surgeons can see the osteotomy depth directly through the incision, reducing frequent X-ray use (fluoroscopy).
No Lateral Cortex Damage: The pre-shaped plate acts as a hinge, keeping the outer bone intact and preventing instability.
Stronger Stability: Dual plates (lateral and medial) hold the bone in place, lowering risks of shifting or rotating.
Widely Accessible: The lateral plate is a standard orthopedic device—most hospitals can perform the procedure without special equipment.

How It Compares to Other Treatments

When compared to recent studies on supramalleolar osteotomy (including research from South Korea and China), this technique performed just as well for:

Relieving pain
Improving mobility
Restoring proper weight-bearing alignment

Early follow-up confirms the procedure is safe and effective—with results that last.

Is This Right for You?

For patients with varus ankle arthritis, this modified osteotomy offers a smarter, safer alternative to traditional surgery. It uses familiar tools, reduces radiation exposure, and lowers complication risks—all while delivering the same (or better) results. The team believes the technique could help more people get back to daily activities like walking, hiking, or playing with kids—pain-free.

Patient Consent: All patients gave written consent for their clinical information and images to be included in the study. Their identities were protected, though complete anonymity cannot be guaranteed.

Funding: The study was supported by the National Natural Science Foundation of China (Grant No. 81702964) and the Co-building Major Project of Zhejiang Provincial Health Commission and the Chinese National Health Commission (Grant No. WKJ2014-2-002).

Conflicts of Interest: The authors declare no conflicts of interest—they have no ties to companies that make the plates or devices used in the study.

Original Study: Gu XH, Chen XJ, Sun C, Zhang JZ, Luo ZP. Varus ankle arthritis: a modified operation with a novel osteotomy and lateral hinge plate fixation technique. Chinese Medical Journal 2019;132(24):2998–3000. doi.org/10.1097/CM9.0000000000000558

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